Horizon (1964–…): Season 44, Episode 6 - Is Alcohol Worse Than Ecstasy? - full transcript

There's been a big rise in the
number of cannabis users

being admitted to hospital with
mental health problems.

The drug GHB, which has
been used by sex attackers

to sedate their victims,
is to be banned by the government.

From amphetamines to alcohol...

This is called crystal meth,
ice and Nazi crank.

The drug methyl amphetamine...

..cannabis to crystal meth...

LSD is far worse even than...heroin.

..ethanol to ecstasy...

I swear to God, this will take
over anything you love,



cos you love that more -
he is master.

Drugs, legal and illegal,
have never been so easily available.

They provoke in the media a
sustained, intense and for the most
part science-free feeding frenzy.

The dangers of taking ecstasy are
again in the spotlight.

Last year, the number of deaths
caused by the drug more than doubled
in England and Wales.

In this film, we examine
the latest scientific evidence

behind 20 of the country's
most widely abused substances.

And ask what is Britain's
most dangerous drug?

Well, a lot of it's mixing,
isn't it, corruption by dealers.

How it effects you physically.

Dependency.

Yes, side effects, long-term
effects, financial effects.

It can also cause
mental instability.

All of them are dangerous.



The illegality of drugs
makes them dangerous.

In the last two years, a group
of British scientists and experts

have been re-evaluating 20 of
the country's most harmful drugs.

If alcohol was invented
today, it would be illegal.

There's no question.

The debate still goes on
as to whether or not
cannabis can cause schizophrenia.

It can certainly cause
an acute psychosis.

If you look at ecstasy, it isn't
a drug that causes significant
problems.

Yet, if you ask the public,
they would probably rate ecstasy as
something that was very dangerous.

The group, led by Professor David
Nutt, had a simple aim - to create

the first scientifically valid list
of drugs ranked in order of harm.

They used three criteria.

One is what the drug does
to the person who takes it.

If it stops you breathing,
that's a serious problem.

And then there's the issue
of how addictive drugs are.

An addictive drug tends to lead
people to use more of it because
they can't break the habit.

And then the third aspect
of drug use, the third harm,

group of harms, comes from
the consequences to society.

As they applied these
criteria to each of the 20 drugs,

it soon became clear how
contentious this approach would be.

Conventional wisdom was left behind
and replaced with a radical
reassessment

of what actually defines
the dangers of a drug.

The resulting list is surprising,

controversial and certain to be
challenged but, most importantly,

it's based not on myth but science.

At number 20,
the least dangerous drug on the list
is a green-leafed shrub called Khat.

This legal stimulant drug makes
the user feel alert and energised,

but used in excess
it can lead to insomnia,
impotence and high blood pressure.

Popular among the Somalian
community, there are estimated
to be 40,000 users in the UK.

It can be harmful, particularly if
it's contaminated with pesticides,

we think it may cause
some people hepatitis.

There have been cases of
individuals becoming psychotic from
using large amounts.

There have been no
recorded deaths from its use.

It's not particularly addictive,
it's not particularly harmful.

At number 19 is another legal drug,

alkyl nitrate,
better known as poppers.

Sniffed straight from the bottle,
it delivers a short sharp high
and relaxes sphincter muscles.

Visibly on sale tonight in London's
West End, poppers or amyl nitrate.

The effect is brief but can leave
the user feeling sick and weak
and is toxic if swallowed.

It's non-addictive and used by
over 400,000 people in the UK.

Both Khat and poppers are legal and
neither are particularly contentious

but the substance next on the list

turns out to be one of the most
controversial Class A drugs in
Britain.

In the 15 years I've worked as a GP,

I've never seen a patient presenting
with a problem with ecstasy.

18 places away from the top of
the list, one of the country's
most infamous drugs...

Ecstasy.

With over half a million users
in just England and Wales, and

a recorded average of 27 deaths
a year, this ranking massively
conflicts with its reputation.

There's always been risks
involved with ecstasy.

We've never quite known
what all those risks are.

There has always been dangers
of brain damage.

It's not been confirmed.

In the early days we didn't
understand why it caused death,

and then we realised it was
due to people dehydrating

First synthesised in 1912,
ecstasy was originally patented
to control bleeding from wounds.

But in the 1970s, it was introduced
illegally into the dance scene.

Most people who take
it once take it again.

It can introduce you to dancing,
to a different way of being,
to sharing a communal spirit,

blokes hugging blokes,
things being nice and simple,

but it can also do your head in.

So what do we know about ecstasy?

We know that it's a stimulant drug

that can bring on mild
hallucinations.

It produces feelings of euphoria,
empathy and energy

and causes increases in body
temperature and heart rate

and when you digest an ecstasy pill

it causes the release of the
chemical messenger serotonin
within the brain,

which is responsible
for regulating mood and memory.

So I can tell you what drugs do now
but what we don't yet understand is

how interacting with those molecules
in the brain leads to long-term
changes in brain function.

There's a lot of work to be done
to understand how the brain adapts

and whether that leads
to long-term problems.

Professor Val Curran has been
studying the effects of ecstasy on
the brain for the past ten years.

The headlines at one point

were very much that
ecstasy could cause brain damage.

Within the past year, the
first research has been published

indicating that chronic use
of ecstasy could impair memory.

And that brain damage
could be permanent.

They say the damage
appears to be irreversible.

And a lot of that was based on
research with rats and with monkeys.

It was difficult to generalise
from animals to humans because

of the very different dosages, the
way it was administered and
the patterns of use over time.

So why is it that it's only number 18
on this list of dangerous drugs?

Some long-term users of ecstasy have
experienced disruptions in memory

and their normal attention
to information,

so it's not a drug that's
hazard-free by any means.

But having said that, many thousands
of people in the UK

have tried it and a good
proportion of those people derived
pleasure and good experience from it

so I'm not going to say that
it's a very dangerous drug.

Professor Curran has carried out
some of the only experiments
in this country

where ecstasy is actually given to
human volunteers in order
to study its effects on the brain.

We gave ecstasy, an 80 milligram
dose, so quite a low dose,

to healthy people who had only
taken the drug a few times

and we studied the
effects in a laboratory,

then recorded a whole range of
cognitive tests including memory.

We did find one problem which was
a deficit two hours after they'd
taken the drug

in terms of memory,
so they were impaired.

But six hours later
they were back to normal.

What our studies have shown is that
when people have given up ecstasy

for at least a year their brains
seem to go entirely back to normal.

They don't differ from people who've
used other kinds of drugs
and not ecstasy.

So it looks like at the moment
that the effects are reversible.

I mean there is always a need for
future research because there might

be a way in which, as the brain
ages, effects might come through,

but they're certainly not as big as
initial research suggested.

Even if other studies have
shown differing opinions

on the dangers of ecstasy,
this group of experts weighing up
all the available evidence

had little doubt that ecstasy
deserved

to be no higher than number 18.

All drugs are harmful to a
certain extent, even aspirin,

but in terms of the risk to the
individual and the risks to society,

it is nowhere near the league
of the other drugs on the list.

Our classification showed ecstasy
was certainly well below most of the
other Class A drugs

and it does seem to be in the
wrong class being Class A.

The origins of the British system
of labelling drugs Classes A, B or C

came about in 1971
after the explosion of recreational
drug use in the 1960s.

As a scientific framework
for assigning the relative weights

to dangerousness of drugs in the UK,
it doesn't have a lot going for it.

And experts from many countries
are working together to assess the
dangers of this new social problem.

And it's this 35-year-old Misuse
of Drugs Act that still defines

the British attitude to drugs today.

Things were put there

owing to very often just prejudice
or ignorance or...

Any way, knowledge has advanced
in the last 30 years

and they've got stuck there.

Nowhere is this discrepancy more
apparent than in the move from

the Class A drug ecstasy
at number 18

to a Class C drug in 17th place.

GHB or Gamma-Hydroxybutyric acid.

More than 5,000 British women

say they've been the victim of
drug-induced date rape.

As a sedative, a small amount of
GHB makes you happy, sensual
and uninhibited.

There have been concerns about
it being used in date rape.

In fact, the evidence is quite low
and very few cases of date rape
probably involve GHB.

You can smell it. It's not a
particularly easy drug to hide.

But its dangers are rated
higher than those of ecstasy

because the difference between
a dose of GHB that gives
a pleasant buzz

and one that can kill you
is barely noticeable.

And when mixed with alcohol
it can be fatal.

The amount used in this country
is unknown but numbers are very low

of three recorded deaths a year.

In 16th place, another Class C drug,
the popular muscle-enhancing
anabolic steroids.

Abuse of these drugs,
can cause enormous amounts of
damage to the individual.

From becoming sterile
to high risk of liver failure
and even strokes or heart attacks.

There are over 42,000 users
in just England and Wales

and the misuse of these drugs can
bring on aggression and violence.

At number 15, we find a
Class B drug, methylphenidate.

The active ingredient
in drugs such as Ritalin,

it is an effective treatment
for ADHD sufferers and used by
around 40,000 prescription users.

These children are being given
psychiatric drugs to control their
bad behaviour.

When used illegally,
the tablets are crushed and
snorted for a quick high.

It's a powerful stimulant, so
if abused can lead to vomiting,

convulsions, tremors and delirium,
as well as dependency.

One in 12 of us will spend some part
of our lives in a place such as this.

The next drug on the list
was also a prescription drug,

initially developed as a circulatory
and respiratory stimulant
in the 1930s

and then, during a 15-year period
beginning in the '50s,

it was prescribed as a
psychiatric treatment to
over 40,000 patients worldwide.

More than half of them are
suffering from a strange
mental disease called schizophrenia.

At number 14 is lysergic acid
diethylamide, LSD.

It is used by over 83,000
people in the UK

yet there have been no recently
recorded deaths from its use.

Dr Ronnie Sandison was one of the
first people in the UK to use it in
psychotherapy over 50 years ago.

LSD really has three effects
on people.

It has a general enhancement
of what's going on inside.

It's all to do with them, it's
all to do with round, with shape.

Everything's coloured,
everything, you know, is...

Oh, it must be to do with orange,
not only with orange, but, oh...

It has some specific effect
in raising forgotten memories,
particularly traumatic memories.

And thirdly, it seems to allow people
the facility to explore those.

LSD did make
an important contribution

to what you might call
science of psychotherapy.

I can do everything.

It fitted in with my idea
of what therapy should be.

The drug was administered in a drink
of water given at the start of...

In the 1960s, it was taken up by the
Army, who tested it on their troops

to see if it could
eventually be used in battle
to incapacitate the enemy.

25 minutes later, the first
effects of the drug became apparent.

The men began to relax and to giggle.

After 35 minutes, one of the radio
operators had become incapable of
using his set

but one hour and ten minutes
after taking the drug,

with one man climbing
a tree to feed the birds,

the troop commander gave up,

admitting that he could no
longer control himself or his men.

And later that decade,
when LSD leaked out into
the recreational market,

it panicked the establishment and
was made an illegal Class A drug.

People who have taken LSD have
gone in through plate-glass windows.

We had people who were inside
with LSD coming out through
plate-glass windows.

Many experts today believe the
dangers of LSD are more
fiction than fact.

It's physiologically non-toxic.

No-one has ever died from an overdose
of LSD.

It's true I think one or two people
in the '60s jumped out of windows but

that's become a myth which goes on
flapping its wings through history.

Dr Ben Sessa is keen to pick up
where Ronnie left off and revived
the use of LSD in therapy.

If you imagine going along to your
typical 50-minute psychotherapy
session once a week,

one might go for months and months

before the defences are broken
down and the real crucial material

comes out, so the role of LSD
is it can speed that process up.

LSD acts firstly on the
brain's serotonin system,

a part of the brain responsible
for feelings of well-being,

and subsequently on the pre-frontal
cortex, which processes some of our
uniquely human abstract thoughts.

It also seems to reduce
communication between
different brain areas,

leading to a loss of inhibitions
and an ability to open up,

and the complex neurological effects
can result in powerful
hallucinations.

So we're giving you this LSD,
you know, to...

Today, despite a growing belief
of its benefits amongst some
parts of the medical community,

the laws have made further use in
psychotherapy almost impossible.

If you say the words LSD to
someone now they think of all the
dangers and the adverse effects.

Don't leave me, please!

We're right to be cautious. These
can be dangerous drugs when used
recreationally

but I firmly believe that
they can be used safely in the
context of the clinical environment.

In a sense, I've done my bit
and I'm very glad to hand on the
mantle as it were to other people

and I'm glad that Ben and others of
similar calibre are taking it on.
It's very encouraging.

If there is a possibility that LSD
or other hallucinogenic drugs

can have therapeutic potential
in psychiatry

then I do believe they should at
least be researched to explore this.

Because to leave that stone unturned
is potentially closing the door

on that group of
patients who may benefit.

At number 13, the Class A drug 4MTA,
a man-made drug

created purely to sell on the street
as an alternative to ecstasy.

State government has banned a lethal
new designer drug called Flatliner,

33 times more powerful than
ecstasy.

Its dangers lie in the fact that
even though it is a stimulant,

it does not produce the euphoric
high that ecstasy does

so users take more and more,
thinking it hasn't worked,
and can eventually overdose.

As a relatively new drug in the UK,
the number of users is unknown.

At number 12, a legal drug far more
dangerous than we often realise.

From glue to paint to aerosols, the
misuse of these drugs is widespread.

The solvents are inhaled so
they get into the lungs very quickly.

Many of them are quite toxic
chemicals like toluene that have a
very toxic effect on the heart.

With over 30,000 users in the UK,
we see an average of 50 to 60 deaths

a year from solvents,
including first-time users.

Somewhere between about five and
20 children a year die either of

the heart stopping when they
sniff the solvent

and others die because they
have it in a plastic bag

and then they go unconscious
and then they inhale the contents.

So from Khat through to solvents,

the scientists have placed a
variety of drugs

from the legal to the very illegal
in the bottom half of their chart.

With drugs like acid, E and GHB
already covered,

at number 11 they reached
a crucial turning point

with the UK's most commonly
used illegal drug, cannabis.

Used by around three million people
in the UK,

it is responsible for
only one recorded death a year.

However, the scientists
had no reservations

in placing it this high on the list.

Do not underestimate cannabis.

It is not a safe drug just because
some people think of it as a herb.

It is not a herb, it is not
a drug that can be used
with no ill effects.

As cannabis is usually smoked, it
hits the brain almost immediately,

effecting cannabinoid receptors
present everywhere in the brain.

In small doses, it induces euphoria,
relaxation and pain relief

but in high doses it can bring on
paranoia and short-term memory loss.

It can also lead to some form of
dependency and it has more recently
been linked to lung cancer.

More controversially,
some scientists have started to

explore the links of long-term
use of cannabis and psychosis.

When we look at cannabis and
psychosis, what we see is that

if you are psychotic, if
you've got schizophrenia,
smoking cannabis is a bad thing.

Of the hundreds of compounds
found in cannabis

it seems one of these chemicals,
THC or tetrahydrocannabinol,

may be linked to
psychotic behaviour.

This compound is being used to see
if it can recreate similar symptoms

in healthy volunteers to those
suffered by schizophrenics.

Schizophrenia is a psychiatric
illness in which patients

will experience a range
of bizarre phenomena,

things like delusions that
some agency is out to get them.

The subjects will be hearing voices
of people who aren't actually there.

Dr Garry Honey has been
conducting a study in Cambridge

where THC is given to the volunteers
intravenously over two hours.

Its concentration and purity mean
that its effects are not comparable
to those of smoking cannabis.

So the THC is getting into the brain
very much more quickly than it would
if you were smoking cannabis.

That's likely to be a very different
experience than the gradual onset

of symptoms that you might
experience with cannabis.

So this is Tom, one of our
volunteers on the study.

We've given him a dose of intravenous
THC and these are the first symptoms
that he began to experience.

Where I'm looking, I can see
in sharp, in intense relief

but...

the rest of my vision
is really closing down and
going out of focus, really.

At that point it was
sort of almost exciting.

It was, this is fun, this is great,

this is a whole new experience.

But it was later on that
it started to get a bit,
a bit more full-on, really.

When healthy volunteers are exposed
to THC, they'll start to experience

some of the symptoms that
are in some ways similar to
the symptoms of schizophrenia.

One hour into the study, the
normally extrovert and eloquent Tom

starts to have problems
expressing himself.

I...I'm hesitating to say that I'm,

it isn't working very. It isn't, um,

I think it isn't...
I can't finish the sentences.

It's bizarre almost watching,
seeing myself do this.

It was really difficult
to keep communicating it and
yet at this point my brain was,

was just on fire and I
was thinking of all these
really interesting things

and, "Oh, I must tell them
about this because I've
just noticed that."

And yet I couldn't because
it was happening far faster
than my mouth could keep up.

Do you feel as if there
is a conspiracy against you?

Yes, but not, um,
it's not very strong.

I remember thinking,

you're asking me whether I'm
suspicious but if I'm suspicious,
I'm not going to tell you.

What we are trying to answer is,
should they become schizophrenic,

what type of symptoms might they
experience?

If we can predict those
symptoms under drug,

the potential is that we could
also predict those symptoms

during the disease
and that would allow us the potential
for early intervention strategies.

In these studies,
pure THC is given

in very high doses
and appears to induce
similar symptoms to schizophrenia

but as yet there is no evidence

that the complex combination
of ingredients in cannabis
can cause psychosis when smoked.

As the controversy linking
cannabis and psychosis rumbles on,

studies across the globe indicate
that the picture is far more
complicated than we realise.

An interesting recent study
came out of New Zealand

and there they showed that smoking
cannabis was associated with
increased risk of psychotic symptoms

but the group that was particularly
at risk had a genetic variant

of a gene which breaks down
dopamine in the brain,

whereas three-quarters
of the population
don't have that genetic variant.

They seem not to be at risk
of getting psychotic symptoms
with cannabis.

So it's a complicated area,
and genetics as well as
cannabis use may play a part.

I love to wake up and have a spliff,

I think it's great.

We'd even smoke in the playground.
The playground, on the benches...

The study in New Zealand
also looked at the age at which
people start smoking cannabis

and they showed that
the earlier start

was associated with more likelihood
of having these psychotic symptoms.

Would you like some more? Yeah.
It's a very hazardous thing to do,

to include into the kind of,

the diet of a young person,
psychoactive drugs.

Their brains are developing,
they are by no means mature,

perhaps not until the first
few years of their twenties.

At number ten, buprenorphine,
a Class C opiate

normally used for severe pain and as
a treatment for heroin dependents.

Buprenorphine is already in use
as an injectable pain killer.

When taken orally
it can block the effect of heroin.

It is used illegally because of its
euphoric and hallucinogenic effects,

but without medical guidance
it is highly addictive

and, being a strong opiate,
it can very easily lead to overdose.

The number of illicit users
in the UK is unknown.

At number nine,
the most deadly drug in the UK.

It kills one fifth of the population
and reduces life expectancy
on average by ten years.

It causes 40%
of all hospital illnesses

and it is one of the most
addictive drugs available -
and yet it remains legal.

In ninth place, the commonly used
and still quite popular drug,
tobacco.

At around ?5 a packet, there are
over ten million smokers in the UK

and it is responsible for
over 114,000 deaths a year.

A lot of people have criticised us
for putting tobacco
into the Lancet paper.

We did it because we thought it was
important that we put in the drug
that most people have experience of,

and so then they could judge
the relative harms and safeties of
other drugs in relation to tobacco.

I shall never give up smoking,

I've been smoking too long now
and I'm still healthy.

So why should we ban smoking?

Smoking alone kills more than drugs,

alcohol, HIV, suicide,

homicide and car crashes combined.

Approximately one of every
two life-long smokers
will eventually die from smoking.

If current trends continue,
five million children alive today

in the UK will die prematurely
of tobacco-related illnesses.

If you smoke three or four
cigarettes you are likely
to be addicted for life.

You are unlikely to be able to be
what some people
call a social smoker.

You are likely to spend the rest
of your days trying to give up.

Nicotine is probably
the most addictive substance

we have currently,
amongst all the substances.

In eighth place, amphetamines.

However, when abused,
they become incredibly addictive.

As tolerance builds up,
so consumption increases,

leading to paranoia and depression,

with heavy use bringing on panic
attacks and violent mood swings.

On the street, they are often cut
with other dangerous chemicals.

Benzodiazepines are known
to most of us by their
pharmaceutical names, like Valium.

They are minor tranquilisers
which are used under prescription

for treating things like anxiety,
insomnia and seizures.

'But after just a few months use,
they can cause dependence
and side effects. For years...'

But illegally abused,
they can lead to memory loss,
nausea, anxiety and depression.

Consumed with alcohol, they're often
fatal and are behind 406 recorded
deaths every year in the UK.

At number six,
another Class C drug, ketamine.

Normally used
as a horse tranquiliser,

it has very strong pain-killing
effects

but has become
a popular illegal drug because
it is such a strong hallucinogen.

It looks like cocaine,
it's snorted like cocaine.

It will give you
a wide range of effects,

including sort of altering reality,
bodily numbness

and a dissociation
from contact with your surroundings,

so that people feel they could
stretch their arm up down
the end of Tottenham Court Road.

It falls into sixth place on
this list because at high doses

it can result in heart failure
and even stop breathing.

It's particularly dangerous
if mixed with any depressant drugs,
including alcohol.

Prolonged use can lead to
psychological dependence
and psychosis.

With only five drugs remaining,
the scientists placed a popular
legal drug after ketamine.

More harmful than ecstasy,
LSD, tobacco,

five Class As and 11 illegal drugs,

something which kills more people
than all of the illegal drugs
on this list combined

and which is nevertheless used
by the majority of the population.

At number five, alcohol.

Around since the earliest days
of civilisation,

it is used by over two-thirds
of the UK population

and is implicated
in around 40,000 deaths each year.

The problem is that when people
think about alcoholism,

they think about the chap
sitting over there in a doorway
with a bottle of cider.

They don't think of the people that
go out after work every night

and they can't function...
Before they go home,

they need to have those three
or four or maybe five drinks.

About the couple that comes home
from work and open a bottle of wine.

I never thought I'd end up on
a bench drinking in the morning.

Alcohol is probably the biggest
problem drug we face today.

I think in terms of the public's
health, it's the biggest
public health problem we face.

I don't think it's the individual.

I don't think we can blame them.

I think it's the fact that alcohol
is so cheap and it's so available

and I think as a society we pay
lip service to the problems.

We almost laugh at the young person
drunk in the street.

We laugh at the hangover that
we had from yesterday's drinking.

What do you think
is the most dangerous drug?

Myself, I would say heroin
and alcohol.

Alcohol is a sedative
and its effects are seen
on the brain within five minutes.

It effects several
neurotransmitters,
including dopamine,

which is found in large quantities
in the brain's reward pathway.

Stimulation of this system not only
causes pleasure but also gives
alcohol its addictive qualities.

Alcohol acts as a depressant,
but at low doses removes inhibitions

so making the person sociable
and talkative.

As doses increase,
speech begins to slur,

it affects co-ordination
and brings on nausea and vomiting.

Long-term use can lead to damage
of the heart, liver and stomach.

I think if alcohol
was introduced today

it would certainly have
many more sanctions on it
than it currently has.

It would probably be classified.

It is the only drug now which we
actively encourage people to use,

which we under price,
which we sell aggressively,

and yet we pick up the consequences,
we pick up the damage all the time.

There are currently over 180,000
alcohol-related hospital admissions
each year.

Deaths have nearly doubled
over the past decade.

Around 40% of A&E admissions
are down to alcohol

and the cost to the NHS
is up to ?1.7 billion a year,

and yet we carry on drinking.

'It's becoming the most serious
social problem in Britain.'

We have to make sure that this form
of what we often call binge drinking

doesn't become
a new sort of British disease.

Professor Theodora Duka
has been studying a new phenomena

in our use of alcohol -
the effects of binge drinking.

We started studying binge drinkers

and compared them
to non-binge drinkers.

Do you see yourselves
as binge drinkers?

Occasionally.

I think I'm a lot more conscious
of how much I drink now
than I was when I was younger.

What do you think constitutes
binge drinking?

Drinking so much you can't see
and you fall over.

Amber and Veronica are involved
in a study examining a link

between binge drinking
and brain damage.

First of all, the volunteers
fill in a questionnaire in order
to determine their drinking habits.

Once a pattern of traits
is established,
they move on to computer tasks.

Which are designed to test
whether the binge drinkers

are different in their cognitive
and emotional function.

Binge drinkers will make a mistake
and go back to a square
that they have visited before.

Binge drinkers have a worse strategy
than non-binge drinkers.

And its effects on the brain?

The type of tasks that appear to be
more impaired are tasks
which are related

to the function
of prefrontal cortex -

that is more responsible
for planning, deciding,

following aims.

It is the prefrontal cortex,
the area of the brain,

that develops so late in life.

The damage being caused comes from
the constant stopping-and-starting
technique of binge drinking,

for example
drinking in excess all weekend
but not at all during the week.

When you, at one session,

drink so much alcohol,
then a lot of alcohol which is toxic

is absorbed going to the brain
and then damages the cells.

Alcohol is then, the next day,
slowly eliminated,

the brain is challenged
to produce a lot of substances

which can be toxic and damaging
for the brain.

If you had to make the choice,
yes, that's what I'm trying to say.

Yes. Ideally you shouldn't drink too
much, whatever you do,

because drinking continuously a lot
is also bad.

If, in a week, you drink, let's say,
two bottles of wine,
it is better to drink them

day by day during the whole week than
two bottles of wine in the weekend.

At number four,
the Class A drug, street Methadone.

As an opiate drug, it's similar
to heroin, but less addictive.

Methadone
is a kind of less-good heroin.

If you ask an opiate addict which
they prefer, they'd always go
for heroin over methadone

but if you haven't got heroin,
methadone's not bad.

Prescribed medically, it reduces
the withdrawal effects of heroin

and tends to lead
to a reduction in heroin use.

But used illegally, it is often
diluted with other ingredients

and strength and necessary dose
can be hard to judge.

If it's used to excess
by people who aren't tolerant,

who haven't been using it,
then a very, very small amount
of street methadone will kill you.

And because
there is no rush like heroin,

when you take it, you can overdose
easily without ever feeling high.

Used illegally
by over 33,000 people in the UK,

it causes an average
of 295 deaths a year.

In third place,

barbiturates,
which used to be prescribed for
depression, anxiety and insomnia.

When used illicitly,
they can make the user feel relaxed,

sociable and good humoured.

The problem with the barbiturates,
and why they score high on our list,

is that if you take an overdose,
you are very likely to die.

Chemist robberies
are such a regular source
of barbiturates and other drugs,

some addicts call them canteens.

The small difference between
a normal dose and an overdose
makes them a highly dangerous drug.

An overdose of barbiturates is
like taking an overdose of alcohol.

They both work on the same parts
of the brain to stop you breathing.

They are so dangerous
that their medical use
has dramatically reduced.

These days, they are only prescribed
to treat very severe insomnia.

Reaching the end of the list,
we find the two most
dangerous drugs in Britain,

as ranked by the scientists, one a
stimulant, and the other an opiate.

They have a number of things
in common.

High levels of harm
to the individual,
huge consequences on society,

and addictive levels
of immense proportions, whether
physiologically or psychologically.

Those two drugs really win the Oscar
for the most harmful substances
that we have.

In second place,
the stimulant, cocaine.

With 780,000 users in England
and Wales alone,

its use is on the increase in the UK

and every year it causes
around 214 recorded deaths.

The use if cocaine in the UK is
now as high as it is in America.

I think it's a rather greedy drug -
it's very to do with money,

snorted with ?20 notes,
and is to do with a kind of greed...

and consumer...and it fuels that.

It's quite a selfish drug.
It turns people in on themselves.

There are two kinds of cocaine.

The powder form, which is snorted,
but then also the rock form.

Crack cocaine
is a smokeable version of cocaine.

It's a more intense high.

It makes you feel really high
for a very short period of time.

Now, that's why people are using it.

It is almost impossible to use
crack cocaine without incurring harm.

It's a form of the drug that reaches
the brain by smoking or injection

very, very rapidly,
and that mainlining effect causes
a high vulnerability for dependence.

For what it's worth,
personally I can do about 37 grams
of rock before I fall over.

That's to the point
where my addiction got me,

that I was of the thoughts that
it would never get me like that,

and it pulled my pants down
and proper gave me a good hiding.

Took eight years of my life
away from me.

So, here we are, at number one.

We can finally reveal
what the scientists see
as Britain's most dangerous drug.

I should imagine it's heroin.

Heroin. Heroin probably. Heroin.

Heroin. Crack or heroin.

Heroin definitely,
I'm not going to inject myself...

I eventually became a heroin addict.

Heroin kills over 700 people a year
in the UK alone.

Heroin is the number-one
harmful drug,

both as a drug itself... It's not
used by an awful lot of people,

but those that do use it,
the majority will not be able
to use it safely.

Either injected or smoked,
heroin is used both as a painkiller
and a recreational drug.

It works on the reward pathway,
which is why it is
intensely habit-forming.

When injected, it can produce
a strong feeling of euphoria

which is akin to an orgasm,
and one dose
can last from one to three hours.

As it effects the part of the brain
that controls breathing,
an overdose can be fatal.

So that's why it's at the top.

It gets in fast, it's very addictive
and it's also very dangerous because
if you overdose on it then you die.

So, as the most dangerous drug
in Britain,

why do more than 300,000 people
in this country take it?

If you've ever had a really hard
day's work and then you go home

and you sit in the comfiest chair
you've got,

and it just envelops you,
and it's like that.

It's just such a nice, warm feeling.

If you're homeless, if you've got
a series of things
that have gone wrong in your life,

if you're in and out of prison,
there is no chance of you working,
then heroin makes perfect sense.

Because it's a painkiller,
it wraps people in a bubble where
the pain of life can't get to you.

I wouldn't walk past someone
and think, "Look at him,
he's a smack head."

I'd think something might have
happened - he could have been
a millionaire, you know?

So, swings and roundabouts,
isn't it?

You know what I mean? Shit happens.

Can I have ten one-mil barrels,
ten long blue...

The experts have no doubt
that heroin
is Britain's most dangerous drug.

It rightfully belongs at the top
of the league table of perceived
dangerousness in the public eye,

and there is enough evidence
clinically and scientifically

that it's a drug that has
a very fierce dependence liability.

Once created,
the sense of heroin dependence
is very difficult to shift.

We've reached the end of the list,
the order of harm in which science

sees 20 of the UK's
most dangerous drugs.

A list which places cannabis,
ecstasy and LSD below tobacco,

and which suggests that alcohol,
if it were a new drug,

would be classified as Class A.

Now we have, I think, a process
for assessing drugs, and
we can use it to assess new drugs.

We also have, I think, a scale,
a ranking of drugs which now needs
to go back to the regulators

and we need to say to them,
"These are the real harms,
as best we can estimate them.

"Now how are you going to frame
the law to take account of this?"

The paper on drug harms, I think
everybody who's looked at it will
rearrange them slightly different.

One of the problems of rank ordering
20 different drugs

is the sheer fact that some of them
are used in combination.

I think it's very hard to find
an objective index of harm,

but this might be a start
to stimulate some good research.

One thing is for sure,
these drugs aren't going away.

I think it's a fact of life that
people have always altered
their consciousness

and they're going to continue
doing so.

And therefore we, as a society,
need to get a very firm grip

on the relative harms
of the different substances,

which we need to teach to our
children, and, rather than forbid,

we need to eductate.

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